Characteristics of patients with obesity presenting with cardiac arrest and the potential role of cardioverter-defibrillator therapy: an analysis using the National Inpatient Sample database.

BACKGROUND: Obesity is a well established risk factor for cardiovascular disease and has been associated with an increased incidence of cardiac arrest. This study utilizes the National Inpatient Sample (NIS) database to analyze the characteristics of obese patients presenting with cardiac arrest and explores the potential role of implantable cardioverter-defibrillator (ICD) therapy in this population.

METHODS: We analyzed data from the NIS database between 2016 and 2020, including obese (body mass index ≥30) adult patients with and without cardiac arrest. Baseline characteristics and comorbidities were identified using relevant ICD-10 codes. Differences in outcomes and comorbidities between the two groups, as well as factors associated with ICD placement, were evaluated using multivariable logistic regression.

RESULTS: We analyzed 4 445 524 obese patients, including 88 770 individuals who presented with cardiac arrest (mean age: 63.2 ± 12.6 years) and 4 356 754 without cardiac arrest (mean age: 59.0 ± 15.2 years). Obese patients with cardiac arrest were more likely to be White men with a greater burden of comorbidities, such as hypertension, chronic ischemic heart disease, smoking, alcohol use, hyperthyroidism, congestive heart failure, and atrial and ventricular arrhythmias, with atrial fibrillation being a particularly dominant association with cardiac arrest (odds ratio: 7.80, P < 0.001). In addition, individuals with private insurance and those treated at large, urban teaching hospitals were more likely to be diagnosed with cardiac arrest, with longer hospital stays, higher costs, and increased mortality. In the setting of cardiac arrest associated with ventricular tachycardia and fibrillation, males with private insurance, higher median household incomes (> $35 000), and treatment at large, urban teaching hospitals had higher odds of ICD placement. Furthermore, obese individuals with advancing age and comorbidities - including diabetes, obstructive lung disease, peripheral vascular disease, and renal and liver disease - faced higher odds of mortality without an ICD. Compared with White patients, Asian, Pacific Islander, and Native American individuals without an ICD also had higher odds of mortality.

CONCLUSION: Obese individuals, particularly White males with comorbidities, were more likely to experience cardiac arrest, with atrial fibrillation being a strong independent risk factor even after adjustment for heart failure. Disparities in healthcare access were evident, with individuals of higher socioeconomic status more likely to receive ICDs, while certain racial groups had worse outcomes.